ABSTRACT
BACKGROUND: Intimal sarcoma is an exceedingly rare type of primary cardiac tumour. It is characterized by poorly differentiated spindle-shaped cells that can mimic smooth muscle and is strongly associated with MDM2 genetic amplification. Owing to its rarity and non-distinctive histological features, diagnosis remains a significant challenge. CASE SUMMARY: In this case report, we describe a case of primary cardiac intimal sarcoma in a 37-year-old woman who presented with atrial fibrillation (AF) and a left atrial mass. Despite having a histological sample from an excised left atrial mass, the diagnosis was not made until she presented with back pain secondary to metastatic disease to the spine. DISCUSSION: Primary cardiac intimal sarcoma is an extremely rare diagnosis. The mainstay management of intimal cardiac sarcoma is aggressive surgical resection. Unfortunately, the prognosis of cardiac sarcomas remains very poor, with a mean survival between 3 months and 1 year. This case of cardiac intimal sarcoma highlights the difficulty in establishing a diagnosis, particularly given the unusual presentation of AF.
ABSTRACT
BACKGROUND: Clinical trials of the effects of statins in people with and without depressive symptoms at baseline have yielded conflicting results with studies reporting both an increase and decrease in depressive symptoms. To address these inconsistences, a systematic review and meta-analysis has been conducted to determine the effects of statins on depression in those with or without clinical major depression. METHODS: A comprehensive literature search was conducted in MEDLINE, EMBASE and PsychINFO to identify relevant articles that met predefined inclusion and exclusion criteria. The primary outcome measure was the mean difference in depression scores at endpoint between the statin and placebo groups which was computed using random effects model. RESULTS: 10 articles were found and used to determine the effects of statins on depressive symptoms. Subgroup analyses were performed to determine the effects of statins in patients with and without depression at baseline. Overall, statin use was associated with significantly lower scores on depression rating scales compared with the placebo use (SMD: -0.309, CI: -0.525, -0.094; pâ¯=â¯0.005). The subgroup analysis showed significant effects in the depressed population (SMD: -0.796, CI: -1.107, -0.486, pâ¯=â¯0.001) but not in the non-depressed population (SMD: -0.153, CI: -0.353, 0.047, pâ¯=â¯0.113). LIMITATIONS: There was high heterogeneity in the studies included and only two studies had low risk of bias. CONCLUSION: The results suggest that statins are effective in improving depressive symptoms, particularly in those with clinical depression and that they do not worsen depression in non-depressed subjects.
